Difficulties on transitioning in Greece
A personal testimony, from a recipient of our services.
Selini Azalea Celeste, Game Developer, Giannitsa 15/9/2025.
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This is the original English version of the article (there’s a Greek one available, too, for Greek speakers, but, chances are, you either don’t speak Greek or, if you do, you’ll still prefer this version). Enjoy!
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In Greece, getting access to necessary gender-affirming treatment is, in my experience, one of the most emotionally taxing experiences I’ve ever had to go through, and, for me, the end is still not quite in sight. Full disclosure, in this text, I’m going to be sharing (parts of) my own personal experience as a transgender person with autism, talking about the disbelief and difficulties I’ve faced (and still do).
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Ever since I understood the concept of gender, I wanted some kind of miracle to happen, and to wake up as the opposite gender, with all that entails. The first time I expressed it was when I was still a preteen, and the second one was a few years into puberty. My family’s reaction was to dismiss it, of course, and to tell me that that was nonsense. I didn’t know that one can change their gender for the longest time (the education system doesn’t explore matters of sexual orientation or gender identity) and, when I learned that it was possible, I initially thought it was unnatural. I don’t know why I didn’t seriously look into it until last year, but when I did, I knew who I am. A lot of things started to make sense: avoiding to look in the mirror, dreams of me as a girl, that stab in the heart every time I saw women wearing clothes I thought looked really cute, but couldn’t wear because of being male, and having been told for my entire life that men have to be masculine. Saying that it was just an awakening would be an understatement; my whole life made sense when I realized it.
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The initial problem I had to deal with was what I would describe as a lack of interest and understanding for my being transgender. My living situation was complicated, and I only really had access to specific mental health professionals, one of whom, at the time, not only didn’t understand anything about transgender people, but who also treated me like my gender identity was something sexual. The only question that person ever asked regarding my gender identity was if I wanted to, and I quote, “have a woman’s chest.” I hope I don’t have to explain how insulting that was, reducing my entire identity to having breasts (because as we all know, breasts are the only thing that makes women female, obviously).
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Once that was dealt with (I finally found another person to help me), the next big problem was proving I was transgender. As I mentioned in the beginning, I’m autistic, which apparently makes me unable to have any desire deeper than the basics (I apparently have the intelligence and emotional depth of a toddler). Proving that my being transgender is not some kind of obsession (I’ve never in my life have had any kind of obsession) was a test of patience, as I literally had to wait multiple months to see if my identity would just go back to being “normal.”
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After finally managing to get an online psychiatrist’s appointment, which was necessary as having a diagnosis for gender dysphoria is practically required for starting hormone therapy (there’s no possibility for self-determination here, more on that later), I was yet again in the hands of someone who doesn’t understand transgender identities. This one asked me if I liked men, which has literally nothing to do with gender identity. Gender identity is different than sexual orientation, and not everything has to be heterosexual! I actually think that, had I answered that I find men attractive, regardless of whether that is true or not, I would have gotten the diagnosis. This is assuming that that person thought that the only thing that makes someone transgender is their preferring the gender that was assigned to them at birth, and not the overwhelming and soul-crushing reality of your body not matching your true identity (I mean, that would be silly, right?). Or maybe that person never intended to believe me in the first place; after all, why would a man want to become a woman? The patriarchy teaches us that the female gender is inferior, so why would someone want to become inferior? It is obviously result of mental illness, right? This is how transphobes think.
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Six months and three days after my initial desire to start hormone therapy, I finally got an appointment with a proper psychiatrist, who was also part of the LGBTQIA+ community. The initial impressions were great! Basic respect for my gender identity was shown, and the person themselves actually knew their stuff. Unfortunately, this one was an advocate for the incredibly uncomfortable and, in some cases, even dangerous process of real-life experience (RLE), which has been widely criticized by transgender people and various mental health professionals since the early 2000s, with an article from the American Medical Association’s Journal of Ethics emphasizing the importance of informed consent[8]. Off the top of my head, I remember reading somewhere that, “real-life experience is uncomfortable as the person’s body doesn’t match their gender identity before starting hormone therapy.” It can be dangerous as not everyone accepts transgender people, and not passing could lead to verbal or even physical violence. There’s also the very real chance that someone does go through RLE, and their psychiatrist is simply not convinced they are truly transgender, thus devastating that person both emotionally and socially (“they’re a freak, don’t speak to them”). At the very least, going through RLE should guarantee access to both hormone therapy and gender reassignment surgery.
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For those unaware, RLE is basically something that the medical community thought was a proper way to prove that one is transgender. It consists of socially transitioning, using your preferred name, and doing stuff that is stereotypically associated with the gender you identify as, such as makeup for transgender women. This practice not only perpetuates gender stereotypes, it is also inappropriate for people whose gender identity doesn’t reside in the binary (excluding the social transition, which is only a mild form of torture), people who identify as both or no genders, or people who change it occasionally. It might sound crazy, but I think people should transition on their own terms. It is also absolutely disgusting for choices of style and expression, such as makeup or feminine clothing, to affect one’s access to gender-affirming treatment. Maybe I, a transgender woman, don’t want to express myself with makeup. Maybe I don’t want to have long hair. Maybe I don’t like wearing feminine clothing. That should all be my own personal choice, and not some lifestyle forced onto me, just so I can earn the right to be myself. Although, personally, I have decided to just give up and do as I’m told, regardless of whether that is safe or comfortable or not (I’m honestly just desperate at this point).
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As of 2022, the 8th version of the WPATH’s (World Professional Association for Transgender Health) standards of care has been released, removing all requirements for real life experience for any and all gender-affirming treatments[1]. This fact is ignored when it comes to specific transgender people, one of whom is myself, and I’m actually not even sure if it’s ever taken into consideration in our country. The average suicide rate for transgender people is around 55,5%[7], with a study showing that the transgender youth who have access to hormone therapy have lower rates of depression and suicidal tendencies[6]. Still, even though a transgender person might have suicidal thoughts simply because of their being denied necessary treatment, they might still be denied because of that fact. Somehow, letting a person suffer more just because they are already suffering, effectively punishing people who have gender dysphoria, the very fact that makes them transgender, is okay with medical professionals. After finally managing to get most of what I needed (kinda), my full mental health history has to now be given to an endocrinologist. This is the reason I have to go through the process of real life experience; the fact that I was once suicidal somehow removes my right to a better life; to expressing myself how I want. It should be noted that just about every civilized country uses an informed consent system, without any need of a diagnosis, and that a 2001 study on transgender women shows that real life experience makes no difference to one’s desire to transition[2]; the rates of regret were found to be the same between those who had gone through RLE and those who hadn’t, I believe. Also, I fail to see the correlation between suicidal tendencies and RLE; one has nothing to do with the other, and going through RLE neither removes said tendencies nor does it prove that one won’t regret their transition. It should also be noted that, from what I’ve read, only 5% of people who stop transitioning do so out of actual regret (less than 3% of trans people in general stop transitioning)[3]; the rest do so because of how difficult transitioning and existing as a transgender person is, or because of pressure from family and/or friends.
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As of the time of writing, I have been trying to start medically transitioning for more than a year. As a study on barriers transgender people face in Greece says[4], “the healthcare system doesn’t measure desire to transition; it measures courage and patience.” Truer words have never been said. It is obvious that education regarding transgender people must be given to both new and old mental health and general healthcare workers, in a way that doesn’t treat transgender identities as a mental illness, but as yet another way to express oneself. Additionally, it is paramount that we switch to an informed consent system as well, not only in theory (it’s not legally necessary to have a diagnosis, nor to undergo RLE[5]), but in practice; this includes applying and following the WPATH’s standards of care (the newest version, not the most restrictive one). There should also not be nearly as much doubt when an autistic person says they’re transgender, especially if they’re high functioning.
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Bibliography:
- : Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Deutsch, M. B., Ettner, R., Fraser, L., Good- man, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of care for the health of transgender and gender di- verse people, version 8. International Journal of Transgender Health, 23(sup1).
- : Lawrence, A. A. (2015). SRS without a one year RLE: Still no regrets. ITGL.
- : GenderGP. (2024, July 5). Detransition facts: Debunking well funded misinformation.
- : Orlando LGBT+. (2023, October). Deliverable No 2.3: Re- port on Learning Outcomes. Transcare. [5]: Law 4491/2017 (ΦΕΚ Α΄ 152, 13.10.2017)
- : Green, A. E., DeChants, J. P., Price, M. N., & Davis, C. K. (2021). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. Journal of Adolescent Health, 70(4), 643–649.
- : Narang, P., Sarai, S. K., Aldrin, S., & Lippmann, S. (2018). Suicide among transgender and gender-nonconforming people. The Primary Care Companion For CNS Disorders, 20(3).
- : Cavanaugh, T., Hopwood, R., & Lambert, C. (2016). In- formed consent in the medical care of transgender and gender- nonconforming patients. AMA Journal of Ethics, 18(11), 1147– 1155.
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